Search

Purpose: To report accuracy, repeatability, and agreement of Cobb angle measurements on radiographs and/or stereo-radiographs (EOS) compared against one another or against other imaging modalities. Methods: This review follows Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A literature search was conducted on 21 July 2021 using Medline, Embase, and Cochrane. Two researchers independently performed title/abstract/ full-text screening and data extraction. Studies were eligible if they reported Cobb angles, and/or their repeatability and agreement, measured on radiographs and/or EOS compared against one another or against other imaging modalities. Results: Of the 2993 records identified, 845 were duplicates and 2212 were excluded during title/abstract/full-text screening. Two more relevant studies were identified from references of eligible studies, leaving 14 studies for inclusion. Two studies compared Cobb angles from EOS vs CT, while 12 compared radiographs vs other imaging modalities: EOS, CT, MRI, digital fluoroscopy, or dual-energy x-ray absorptiometry. Angles from standing radiographs tended to be higher than those from supine MRI and CT, and angles from standing EOS tended to be higher than those from supine or prone CT. Correlations across modalities were strong (R = 0.78–0.97). Inter-observer agreement was excellent for all studies (ICC = 0.77–1.00), except one (ICC = 0.13 radiographs and ICC = 0.68 for MRI). Conclusion: Differences of up to 11º were found when comparing Cobb angles across combinations of imaging modalities and patient positions. It is not possible, however, to determine whether the differences observed are due to the change of modality, position, or both. Therefore, clinicians should be careful when utilizing the thresholds for standing radiographs across other modalities and positions for diagnosis and assessment of scoliosis.

Objective: This study aimed to systematically review the literature for comparative and non-comparative studies reporting on clinical outcomes of patients with lumbar foraminal stenosis treated by either endoscopic foraminotomy or fusion. Methods: In adherence with Preferred Reporting Items for Systematic reviews and Meta- Analyses guidelines, a literature search was done on January 17, 2022, using Medline and Embase. Clinical studies were eligible if they reported outcomes following fusion or endoscopic foraminotomy, in patients with primary lumbar foraminal stenosis. Two independent reviewers screened titles, abstracts, and full-texts to determine eligibility; performed data extraction; and assessed the quality of eligible studies according to the Joanna Briggs Institute (JBI) checklist. Results: The search returned 827 records; 266 were duplicates, 538 were excluded after title/abstract/full-text screening, and 23 were eligible, with 16 case series reporting on endoscopic foraminotomy, 7 case series reporting on fusion, and no comparative studies. The JBI checklist indicated that 21 studies scored ≥4 points. When comparing endoscopic foraminotomy to fusion, pooled data revealed reduced operative time (69 vs 119 min, P < 0.01) but similar Oswestry disability index (19 vs 20, P = 0.67), lower back pain (2 vs 2, P = 0.11), leg pain (2 vs 2, P = 0.15), complication rates (10% vs 5%, P = 0.22), and reoperation rates (5% vs 0%, P = 0.16). The proportions of patients with good/excellent MacNab criteria were similar for endoscopic foraminotomy and fusion (82–91% vs 85–91%). Conclusions: There were high heterogeneity and no significant differences in clinical outcomes, complication rates, and reoperation rates between endoscopic foraminotomy and fusion for the treatment of lumbar foraminal stenosis; although endoscopic foraminotomy has reduced operative time.

Abstract Purpose To determine within‐patient fusion rates of chambers filled with bioactive glass versus autologous iliac crest bone on computed tomography (CT) following anterior lumbar interbody fusion (ALIF). Methods A consecutive series of 40 patients (58 levels) that underwent single‐level (L5‐S1 only) or two‐level (L5‐S1 and L4‐L5) ALIF were assessed. Indications for fusion were one or more of the following: degenerative disc disease with or without Modic changes, spondylolisthesis, and stenosis. Each intervertebral cage had a middle beam delimiting two chambers, one of which was filled with bioactive glass and the other with autologous iliac crest bone. CT scans were graded using the Bridwell classification (grade I, best; grade IV, worst). Patients were evaluated using the Oswestry Disability Index (ODI), and by rating pain in the lower back and legs on a Visual Analog Scale (pVAS); complications and reoperations were noted. Results At 15 ± 5 months follow‐up, there were no significant differences in fusion across chambers filled with bioactive glass versus chambers filled with autologous bone (p = 0.416). Two patients with Bridwell grade III at both chambers of the L4‐L5 cages required reoperation using posterior instrumentation. Clinical assessment of the 38 remaining patients (54 levels) at 25 ± 2 months, revealed ODI of 15 ± 12, lower back pVAS of 1.4 ± 1.5 and legs pVAS of 1.9 ± 1.6. Conclusions For ALIF at L5‐S1 or L4‐L5, within‐patient fusion rates were equivalent for bioactive glass compared to autologous iliac crest bone; thus, bioactive glass can substitute autologous bone, avoiding increased operative time and blood loss, as well as donor site morbidity.

Objective: To evaluate the clinical and radiological outcomes of patients undergoing one-level oblique lumbar interbody fusion (OLIF) combined with posterolateral fusion (PLF) with pedicle screws for the treatment of degenerative lumbar spondylolisthesis (DS) with a minimum follow-up of 1 year. Methods: A retrospective analysis of prospectively collected data was performed. Patients who underwent combined OLIF and PLF between March 2013 and December 2019 were considered for study eligibility. Patients were evaluated using the Oswestry Disability Index (ODI) and the Short Form-12 (SF-12) (physical PCS, mental MCS), self-evaluation of pain with a Visual Analog Scale (VAS) and walking distance. Compensation and sagittal balance were assessed using the Gille classification by full spine stereoradiography (EOS Imaging, Paris, France). Mechanical complications were also collected. Results: A total of 131 patients were included (mean (SD) age: 64.2 ± 10.4 years), and 127 patients were evaluated after a mean follow-up of 22 ± 12.3 months. The mean ODI at the last follow-up was 13.8 ± 12.9% (gain of 32.3 ± 15.5%; p 40 mm) had a significant improvement in SVA of 19.8 ± 32 mm (p = 0.025). Sagittal imbalance (Gille type 3) was not associated with a change in postoperative functional score (p = 0.52). Conclusions: OLIF improved functional scores at 1 year, with excellent outcomes in 80% of our patients with a low morbidity. Sagittal imbalance did not adversely affect the clinical outcomes. Level of evidence: 4 (cohort study).

Objectives: To assess early clinical outcomes of stand-alone minimally invasive ALIF for patients with DDD at L4-L5 and determine whether the procedure affects spino-pelvic parameters. Methods: The authors reviewed the records of all patients with DDD that underwent stand-alone minimally invasive ALIF at L4-L5 using the self-locking SynFix cage (DePuy Synthes, PA, USA). Patients were evaluated using the Oswestry Disability Index (ODI), Short Form 12, and lower back and legs pain on Visual Analog Scale. Spino-pelvic parameters were measured from whole-spine standing radiographs. Results: From the initial cohort of 48 patients, 3 could not be reached, and 4 were reoperated due to pseudarthrosis using posterior instrumentation with bone graft, leaving 41 for clinical and radiologic evaluation. At a follow-up of 18.2 ± 7.3 months, all 5 clinical scores improved from pre-operative values. Multi-variable regressions revealed no significant associations between independent variables and ODI. Comparing pre- and post-operative radiographs: global lumbar lordosis increased by 3.6 ± 7.7° (p = 0.001), L4-L5 lordosis increased by 7.4 ± 6.1° (p